Crazy Advertising for Medicare Advantage/Supplement Plans

[aja8888]

What I have discovered by having Long Covid is everything is NOT covered. If you have a well known heart condition or a broken arm, a lot of treatments (but not all) are covered. What is not covered in well hidden, but the doctors know what they can and cannot prescribe based on the codes. Hanging out in doctors' offices, I have heard doctors tell nurses and PA's no you can't prescribe that under Medicare, the alternative is x (something less effective but a lot cheaper.) It's almost impossible to get the neurological testing I need, because there is no diagnosis and corresponding code for this. But I can get a sleep study and a CPAP machine, which are routinely approved.

I have original Medicare and AARP/UHC Plan F. The so-called gold standard. My treatment across two different health care organizations has been more like Medi-Cal (California Medicaid) than what I expected from Medicare. The supplement pays with no argument, but only for tests and procedures approved by Medicare.

I have to agree that not everything is covered. I've had two hip replacements, DW has had a heart valve replaced and several other surgeries, plus she's on O2 which is covered. We have never run into a procedure that was not covered. I understand that some cancer drugs are not covered but we haven't been there yet.

 

[ivinsfan]

I have to agree that not everything is covered. I've had two hip replacements, DW has had a heart valve replaced and several other surgeries, plus she's on O2 which is covered. We have never run into a procedure that was not covered. I understand that some cancer drugs are not covered but we haven't been there yet.

Yes the DH had an 8 hour open heart cardiac procedure, 4 days in ICU, 8 days inpatient dozens xrays, lab work, blood and platelets, 10 weeks of cardio rehab and our grand total out of pocket was $0..


Medicare or not there has always been a list of approved steps and treatments for payment. Is that fair in a Covid world? I understand AR's frustrations with the system.

 

[Elliotgb183]

I get all the phone calls and mail bloat as well.

I generally answer the phone now and say in my finest, cheesiest Irish Brogue “St Charles Rectory, Father O’Brian speaking”. “How May I help you today?” "Can I say a prayer for you”.

I generally get a fast click hang up

 

[flyingaway]

I am not Medicare eligible yet, but I got phone calls for extended car warranties every day.

 

[podpoet]

rotfl

I get all the phone calls and mail bloat as well.

I generally answer the phone now and say in my finest, cheesiest Irish Brogue “St Charles Rectory, Father O’Brian speaking”. “How May I help you today?” "Can I say a prayer for you”.

I generally get a fast click hang up

Best laugh I've had all day Thanks.

 

[VanWinkle]

I get all the phone calls and mail bloat as well.

I generally answer the phone now and say in my finest, cheesiest Irish Brogue “St Charles Rectory, Father O’Brian speaking”. “How May I help you today?” "Can I say a prayer for you”.

I generally get a fast click hang up

Bless you Father!!!!

 

[aja8888]

I am not Medicare eligible yet, but I got phone calls for extended car warranties every day.

That's preschool for Medicare Plan calls!

 

[aja8888]

OK, new one:

DW got a call from a local funeral parlor a while back asking if we were interested in seeing their "plans".

This must be the next level of marketing calls.

 

[NW-Bound]

Reading this thread, I am glad that I am not singled out for phone harassment by Medicare Advantage pushers. I just let my answering machine take care of the calls, but it is still annoying to hear the ring throughout the day.

We also get tons of mailings pushing Medicare Advantage. I told my wife they have to get a lot more money with Advantage compared to Medigap to push it that hard. And that makes me leery, though I didn't know all the details.

And I am glad I don't believe in things that are too good to be true, and we are on traditional Medicare for that reason. Plus the fact that going from Advantage back to Medigap involves a lot of hurdles tells me something not good is going on, and makes me suspicious.

This was an interesting article
https://www.bloomberg.com/news/arti...grams-don-t-save-government-money-critics-say:

Thanks. That helps explain a lot.

I'm curious, too. Perhaps it's my ignorance, but I don't see how people on Medicaid can be sought-after customers for anything. They don't have any money! And if the really good benefits are only for Medicaid, then why do the ads all trumpet "Medicare"? How would the Medicaid recipients even know to call?

They make money off of our government.

 

[Maidensong]

This is a ledge I had to talk my 86 year old Dad off of this year, so I've done some research.

Medicare Advantage plans spend a lot of time and money trying to distract us from the main reasons we choose health insurance:
1. Choice of Doctor and hospital
2. Access to that care
3. Clearly defined benefits

With MA, you MUST remain in network to be covered or your costs skyrocket. (If for example, you take a vacation to another state, you may have trouble getting medical care unless its deemed an emergency. Original Medicare plus a Supplement travels with you.

With MA, you will have a gatekeeper--either your primary physician or one of their bean counters--from whom you will need a referral if you want to see a specialist, and then it has to be one in your network. With Original Medicare and a Supplement, I can make an appointment with any doctor I like, wherever they may be located. I can go to the Mayo Clinic to see a pulmonologist if I want. Any doctor or hospital that accepts Medicare will see me.

With MA, the insurance company can decide to cover you or not. There are no pre-determined criteria for acceptance of a claim. Each company makes their own rules. If, for example, you have hip surgery and require skilled nursing care during rehab, after a few days in the facility, your MA can decide you are "custodial" and turn off the benefits at their discretion, leaving you to recover from surgery with a huge bill for your convalescent care as well.

Plus if you want to change from Original Medicare plus a Supplement to Medicare Advantage, it's easy-peasy. But if you want to switch from MA back to the true Cadillac care, you'll face underwriting based on health questions and age and end up with seriously higher premiums than if you'd started and stayed with Original Medicare +Supplement in the first place.

All those stupid commercials are a distraction. "Look at these shiny things over here" to keep you from focusing on what you really need--health insurance that will protect you not only in times of medical necessity, but also from possible financial ruin. When something seems too good to be true, it is. Nothing is free.

MA is a con, IMO. It's fine if you stay healthy, but be warned if you don't.

 

[VanWinkle]

This is a ledge I had to talk my 86 year old Dad off of this year, so I've done some research.

Medicare Advantage plans spend a lot of time and money trying to distract us from the main reasons we choose health insurance:
1. Choice of Doctor and hospital
2. Access to that care
3. Clearly defined benefits

With MA, you MUST remain in network to be covered or your costs skyrocket. (If for example, you take a vacation to another state, you may have trouble getting medical care unless its deemed an emergency. Original Medicare plus a Supplement travels with you.

With MA, you will have a gatekeeper--either your primary physician or one of their bean counters--from whom you will need a referral if you want to see a specialist, and then it has to be one in your network. With Original Medicare and a Supplement, I can make an appointment with any doctor I like, wherever they may be located. I can go to the Mayo Clinic to see a pulmonologist if I want. Any doctor or hospital that accepts Medicare will see me.

With MA, the insurance company can decide to cover you or not. There are no pre-determined criteria for acceptance of a claim. Each company makes their own rules. If, for example, you have hip surgery and require skilled nursing care during rehab, after a few days in the facility, your MA can decide you are "custodial" and turn off the benefits at their discretion, leaving you to recover from surgery with a huge bill for your convalescent care as well.

Plus if you want to change from Original Medicare plus a Supplement to Medicare Advantage, it's easy-peasy. But if you want to switch from MA back to the true Cadillac care, you'll face underwriting based on health questions and age and end up with seriously higher premiums than if you'd started and stayed with Original Medicare +Supplement in the first place.

All those stupid commercials are a distraction. "Look at these shiny things over here" to keep you from focusing on what you really need--health insurance that will protect you not only in times of medical necessity, but also from possible financial ruin. When something seems too good to be true, it is. Nothing is free.

MA is a con, IMO. It's fine if you stay healthy, but be warned if you don't.

Most of your points are aimed at a HMO medicare advantage plan and do not apply to a National PPO plan like AARP Medicare Advantage through United
Healthcare. The Insurance companies are required to cover the same procedures as Medicare. Medicare can also make decisions on Skilled Nursing that the Medigap policy will follow resulting in non-payment.
It is a personal decision based on many factors. Not everyone drives a Cadillac even if they can afford to drive it.

VW

 

[aja8888]

Most of your points are aimed at a HMO medicare advantage plan and do not apply to a National PPO plan like AARP Medicare Advantage through United
Healthcare. The Insurance companies are required to cover the same procedures as Medicare. Medicare can also make decisions on Skilled Nursing that the Medigap policy will follow resulting in non-payment.
It is a personal decision based on many factors. Not everyone drives a Cadillac even if they can afford to drive it.

VW

Exactly, the MA PPO plans around here (Houston, area) are taken by almost all the doctors and support facilities. I have two friends who have them and they have no problems with coverage.

 

[MissMolly]

Yeah, same. All doctors I've ever gone to here take my MA PPO plan. I have nationwide coverage (Humana). I don't need a referral to go to a specialist. We have a top-notch cancer center and heart center in town. They cover everything Medicare covers plus more. I take an expensive medication that would cost me $800/month on Part D. My MA plan covers it so I only pay $110/month.

 

[momoftwo]

I'm extremely thankful I have very inexpensive retiree supplemental from my megacorp.
It was part of a benefit package I earned after 42 yrs.

I agree the overwhelming TV advertising is really annoying. I guess if I didn't have what I do, I'd be calling that number.

Our adult disabled daughter has both Medicare and Medicaid. She indeed does have no premium, no deductible, zero copay prescriptions due to 'extra help'.
She theoretically has dental and vision if she could find a reputable provider within reasonable distance accepting new patients.
Thankful for what she has. But certainly not perfect.

 

[clifp]

This is a ledge I had to talk my 86 year old Dad off of this year, so I've done some research.

Medicare Advantage plans spend a lot of time and money trying to distract us from the main reasons we choose health insurance:
1. Choice of Doctor and hospital
2. Access to that care
3. Clearly defined benefits

With MA, you MUST remain in network to be covered or your costs skyrocket. (If for example, you take a vacation to another state, you may have trouble getting medical care unless its deemed an emergency. Original Medicare plus a Supplement travels with you.


MA is a con, IMO. It's fine if you stay healthy, but be warned if you don't.

I'm still two years away from Medicare, and have mostly ignored the Medicare threads over the decades.

Thank you for the nice summary, that explains a lot.

 

[CardsFan]

Exactly, the MA PPO plans around here (Houston, area) are taken by almost all the doctors and support facilities. I have two friends who have them and they have no problems with coverage.

Yeah, same. All doctors I've ever gone to here take my MA PPO plan. I have nationwide coverage (Humana). I don't need a referral to go to a specialist. We have a top-notch cancer center and heart center in town. They cover everything Medicare covers plus more. I take an expensive medication that would cost me $800/month on Part D. My MA plan covers it so I only pay $110/month.

Just curious. Are you on a "free MA plan" or do you also have a monthly cost? If so, about how much?

 

[MissMolly]

Just curious. Are you on a "free MA plan" or do you also have a monthly cost? If so, about how much?

Actually, I am on a retiree benefit plan.

 

[ivinsfan]

Actually, I am on a retiree benefit plan.

As far as Humana they say they are nationwide but they are not.

 

[MissMolly]

Yep, you got me on that. They are only in 46 states. Gimme a break.

 

[aja8888]

Just curious. Are you on a "free MA plan" or do you also have a monthly cost? If so, about how much?

Currently on a Med Sup. If it goes too high, which I am sure it will once I hit 80, then I'll switch to a PPO.

 

[ivinsfan]

Yep, you got me on that. They are only in 46 states. Gimme a break.

90% then... I had a salesman tell me they are "nationwide" and when I asked him to double check our snowbird state....Crickets.


It's kind of an important detail. If someone reading here thinks they are nationwide they aren't. Why do you need a break. With every insurance if you spend time out of your home state you need figure this out for yourself.

 

[RobbieB]

Haha, yeah we're nation wide, CA, AZ, NM, TX, AR, TN, VA

We're coast to coast, Oregon and South Carolina!

 

[jazz4cash]

You can compare for yourself at Medicare.gov.

No need to endure the sales pitch...just follow the questions and enter your zip and you get the plans available in your area.

These are MEDICARE plans, and YES some do offer the things you hear on TV.

Thanks for making it so simple. I was confused at first but then I clicked
>Continue without logging in
>Medicare Advantage Plan
>Enter Zip Code ( why does that matter? Seems unfair)
>Select my county since my zip covers more than one.
>Answer multiple choice question about other programs (Medicaid, etc)
>Optional to show drug costs but you must enter details of drugs prescribed

I get a list of 19 plans that include PPO, HMO, and MSA. The premiums range from 0 to 100 without drug coverage details but every plan says I still have to pay Part B premium.
The tool has good potential to do some “what if” comparisons.

I still don’t know what I’m looking at….will need to do deep dive on laptop instead of phone.

 

[jazz4cash]

I
My thinking on all the commercials you see, these companies are overpaid if they can afford all that TV time.

I’m thinking this must be very lucrative so should I invest in some of these that are public ?

 

[jazz4cash]

What is the deal? None of this makes any sense to me and I've ignored it in years past. We actually basic Medicare A&B and Federal Retiree Annuitant Supplement Plans, along with Vision and Dental plans provided by the Federal Government, but several friends have brought up these crazy adds.

Is all of this advertising just hogwash?

I was disappointed to find that FEHB premiums are the same for retirees as active employees even though the coverage is reduced to secondary once you are eligible for Medicare. I guess you can select a lower cost plan but we haven’t looked into it. All Family members say just suck it up and pay both premiums. I need a strategy for IRMAA.